MEDICARE: ASPIRING MINDS PSYCHOLOGICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1891499000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPIRING MINDS PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	11815 SHORTHORN RD
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-7150
Country	:	US
Telephone Number	:	719-492-9914
Fax Number	:

Provider Business Practice Location Address
First Line	:	5155 N ACADEMY BLVD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4053
Country	:	US
Telephone Number	:	719-493-5619
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MELANIE DOREEN HOFFMAN
Credential	:	PHD
Telephone Number	:	719-492-9914

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	01/25/2024

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